Although there is no cure for periodontal disease, there are ways to control the progression and dramatically minimize the risk of tooth loss.At Implant & Periodontal Associates Northwest, we offer both surgical and non-surgical approaches to halt the progression of the disease, help prevent further breakdown of the gums and supporting structures, and create a healthy, stable oral environment.

Bone Grafting

When gum tissue becomes severely infected, treatment usually involves removing the damaged pockets and recontouring the uneven bone tissue to discourage new bacteria from forming, and help gum tissue adhere.

Although this is still an effective way of treating gum disease, we perform procedures that actually regenerate lost gum and bone tissue. Guided tissue regeneration can stabilize weak areas and also help provide a foundation for the placement of dental implants.

After pockets have been removed and bacteria eliminated, we insert barrier membranes over the areas where tissue needs to be restored. The membrane encourages the growth of new bone tissue. Depending on the type of membrane used, it will either be removed at a later date or will be absorbed by the body. Guided tissue regeneration is generally performed in conjunction with other procedures.

Crown Lengthening

A periodontal procedure to fix "gummy" smiles.

Occasionally, periodontal procedures are performed for cosmetic reasons. Teeth that appear too short are often regular length, but are covered by too much gum tissue. To correct this, we can perform a procedure called crown lengthening.

During this procedure, excess gum and bone tissue are reshaped to expose more of the natural tooth. This can be done to one or more teeth to expose a natural, broad smile.

Crown lengthening is also done to prep teeth for other cosmetic or restorative procedures. If a tooth is decayed, broken below the gum line, or has insufficient tooth structure for a restoration, crown lengthening can adjust the gum and bone levels to expose more of the tooth so it can be restored.

With crown lengthening, patients often experience both aesthetic and functional benefits, enjoying a beautiful new smile and improved periodontal health.

Frenectomy and Fiberotomy

Occasionally, abnormalities in a patient's connective tissue can interfere with oral health or the success of orthodontia and other procedures. Frenectomy and fiberotomy are two ways we can surgically correct for these problems.FrenectomyThis is the surgical removal of the lingual or labial frenums, which are pieces of tissue that extend from the lips, cheek, and tongue to the gums (if you place your tongue in the space between your upper lip and upper front teeth, you can probably feel one of your frenums).

In certain cases, a frenum can prevent teeth from staying in place after they have been orthodontically moved together. In the lower front teeth, the frenum can pull the gum away from the teeth and cause gum recession, or the loosening of dentures. In a frenectomy, we snip the troublesome tissue, then stitch it up with dissolvable sutures.FiberotomyThis surgery detaches certain rubber band-like fibers, which are very similar to muscle tendons that hold teeth into position. Orthodontic patients often need this procedure to prevent fibers from pulling teeth back to their original position. The procedure is also very simple and painless, and no stitches are required.

Gingivectomy

Patients with braces sometimes need this procedure.

When medications, inflammation, or bone growth abnormalities lead to excess gum tissue, a gingivectomy may be recommended to remove it. This procedure is commonly performed for cosmetic and functional reasons, or to shrink deep gum pockets. If it's part of pocket treatment, it may require some bone work as well.

In this procedure, we anesthetize the area, then remove excess tissue. In most cases, no stitches are required. Patients can expect some soreness for a day or two, which can be alleviated with medication.

LANAP&reg Therapy

We were the first periodontists in Washington to perform LANAP&reg (Laser-Assisted New Attachment Procedure), a treatment that has been shown to help grow new cells in the tooth root and connective tissue, so there's less chance of tooth loss and other common problems associated with periodontal disease.

Older, traditional therapies simply remove diseased tissue and seal the area to halt further damage. But LANAP stimulates the growth of new cells in the tooth root and connective tissue, reducing the chance of tooth loss. No cutting or stitching is required. LANAP also has a faster treatment and recovery time than older methods.

How does it work? First, we measure pocket depth using a periodontal probe. Then, we use a special laser to efficiently remove diseased gum tissue and prepare bacterial calculus (tartar) for removal with an ultrasonic scaler. The laser finishes the debridement of the diseased pocket, compressing the gum tissue against the root surface to stabilize it.

LANAP can generally be performed in one or two visits. We also require a short follow-up visit. The recovery time is very quick. Most patients return to normal activities within 24 hours. They usually feel comfortable enough to eat anything they want after the procedure, but we recommend a diet of soft foods for two days following LANAP.

Biopsy/Oral Pathology

When you come in for an evaluation, we will perform a thorough oral cancer screening. We look at the entire anatomy of the mouth, including the lips, tongue and uvula. If we discover an abnormality, we will perform a biopsy.

A biopsy involves the removal of some or all of the abnormal tissue, which we send to a pathology lab for an examination. If it's troublesome, we will recommend follow-up care. Typically, biopsies will identify oral cancer as well as non-cancerous mouth sores.

Biopsies are usually performed under local anesthesia, with a numbing injection. We remove the tissue, then repair it with stitches. In most cases, the stitches will dissolve in about two weeks. The entire process, from start to finish, takes about 15 minutes. There's no special preparation for a biopsy.

After the numbness wears off, the area may be sore for a few days, which can usually be relieved with over-the-counter medication. Since the stitches are dissolvable, a review appointment is not always necessary, but we will call to discuss biopsy results.

Orthodontic Tooth Uncovering

The canines, or eye teeth, erupt into the mouth between the ages of 11 and 13. Sometimes they come in the wrong position, and if not corrected, can damage the roots of the adjacent teeth or even push them out of position. Though it's most common in the canine teeth, other teeth in the mouth can have the same problem.

This procedure uncovers the impacted teeth so the orthodontist can move them into proper position. We start by placing anesthetic in the surrounding tissues, then push back the gum to expose the tooth. Occasionally, some of the bone surrounding the crown of the tooth is removed.

Once the tooth is exposed, either your periodontist or orthodontist will apply a bracket and chain to the tooth. Afterwards, patients may experience some discomfort and swelling, for which precautions will be recommended. Ongoing appointments with an orthodontist will be necessary.

Perioscopy

A deep cleaning to remove all traces of bacteria.

This technology, which allows us to see, diagnose, and treat periodontal disease below the gum line, has produced some amazing results for our patients. As an initial therapy, perioscopy allows us to completely visualize the root and remove bacteria from the root of the teeth. It's commonly used in conjunction with LANAP, a highly innovative treatment that not only eradicates bacteria within the gum tissue, but actually stimulates bone regeneration.

We perform perioscopy on patients with aggressive or chronic periodontitis affecting one or more deep periodontal pockets. Using a miniature dental endoscope with advanced video, lighting and magnification technology, we identify areas of bacteria present below the gum line and then clean them with very small, ultrasonically powered probes called micro ultrasonics. Images from the endoscope are displayed on a chair-side video screen so you and your dentist can see them.

The goal of perioscopy is to get your tooth root exceptionally clean, and thoroughly remove bacteria from deep pockets. Patients will typically see a decrease in bleeding and inflammation, and their risk of disease progression will diminish. The recovery period is typically 24 hours, so patients are able to get back to work and daily activities very quickly.

Pocket Reduction

The main cause of periodontal disease is bacteria, which forms a sticky, colorless plaque on the teeth. If allowed to build up, the bacteria produce acids that destroy the bone and gum tissue that support your teeth.

In healthy patients, this gum tissue fits snugly around the teeth, surrounding them like a turtleneck sweater. In periodontal patients, this tissue is destroyed. Instead of fitting snugly, gaps or pockets form and become deeper. The deep pockets accumulate even more bacteria, which penetrates even deeper. As the cycle advances, the supporting tissue becomes so damaged the teeth may need to be extracted.

Pocket reduction surgery, known as osseous surgery, can put a stop to this vicious cycle. In this procedure, we pull back the gum tissue, remove the bacteria, then secure the gum tissue back in place. In some cases, irregular surfaces are smoothed to limit areas where disease-causing bacteria can hide, allowing the gum tissue to better reattach to healthy bone.

Together with daily oral hygiene and professional maintenance, osseous surgery can help patients avoid extractions and keep natural teeth, as well as decrease the risk of serious health problems associated with periodontal disease.

Scaling and Root Planing

Removing bacteria above, below and within the gum line.

A very thorough version of a dental cleaning, this is an initial treatment designed to remove all biofilm (soft plaque) and calculus (tartar) from above, and within the deep pockets of the gum line. Scaling and root planning is often the first step toward achieving periodontal health and stability. With proper care, it can halt the progression of periodontal disease.

Depending on a patient's condition, this procedure can be completed in one or more appointments, typically under local anesthetic, for comfort. We may also incorporate chemotherapeutic agents and anti-microbial rinses (Chlorhexidine) into your treatment.

Soft Tissue Grafts

Tissue grafts restore lost gum tissue.

Gum recession is a common side effect of periodontal disease, but may be caused by trauma, aggressive tooth brushing, or other factors. Exposed tooth roots can make teeth more sensitive to hot and cold, and more likely to decay.

Soft tissue grafts are used to cover roots or develop gum tissue. This procedure can reduce further recession and bone loss, and in some cases it can cover exposed roots to protect them from decay, reduce sensitivity and improve the looks of a patient's smile.

In this procedure, we use donor tissue or soft tissue from the patient to cover the exposed root of one or more teeth. There are several different types of grafts that can be done: connective tissue grafts, gingival grafts and pedicle grafts. Depending on your situation, we'll recommend the graft procedure that's ideal for you.

Tooth Removal

Though we make every effort to preserve a patient's natural smile, sometimes teeth have to be removed. Common reasons include severe decay and damage, advanced periodontal disease, or poor tooth position (impaction). Teeth are also sometimes pulled in preparation for orthodontic treatment.

In an extraction procedure, we begin by numbing the area with a local anesthetic. This prevents the nerves from transferring pain signals. However, patients may feel pressure as we widen the socket to allow for removal.

Some teeth require sectioning, a very common procedure when the tooth root is curved, or so firmly anchored into its socket that it can't be removed in one piece. In this case, the doctor simply cuts the tooth into sections, then extracts it one section one at a time.